Fixed Bicortical Screw and Blade Implants as a Non-Standard Solution to an Edentulous (Toothless) Mandible

Aim This paper deals with the treatment of an atrophied toothless mandible with a fixing bridge carried by two nonstandard implant systems. Methodology Four bicortical screws were implanted into the frontal part of the mandible and one implant on each side was placed into the distal area of the mandible as a support for a fixing bridge. Results During the years 2002–2007 the authors placed a total of 256 bicortical screw and 84 blade implants. During this period only four bicortical screws and one blade implant failed. The primary and secondary surgical success rate was therefore above 98%, while the prosthetic success rate was 100%. （Bridges which had to be re-fabricated due to implant failure were not taken into account.） Conclusion This approach is recommended as a highly successful and affordable option for a wide range of patients.

Posterior partially edentulous jaws, planning a rehabilitation with dental implants

AIM: To discuss important characteristics of the useof dental implants in posterior quadrants and the rehabilitation planning. METHODS: An electronic search of English articles was conducted on MEDLINE(PubM ed) from 1990 up to the period of March 2014. The key terms were dental implants and posterior jaws, dental implants/treatment planning and posterior maxilla, and dental implants/treatment planning and posterior mandible. No exclusion criteria were used for the initial search. Clinical trials, randomized and non randomized studies, classical and comparative studies, multicenter studies, in vitro and in vivo studies, case reports, longitudinal studies and reviews of the literature were included in this review. RESULTS: One hundred and fifty-two articles met the inclusion criteria of treatment planning of dental implants in posterior jaw and were read in their entirety. The selected articles were categorized with respect to their context on space for restoration, anatomic considerations(bone quantity and density), radiographic techniques, implant selection(number, position, diameter and surface), tilted and pterygoid implants, short implants, occlusal considerations, and success rates of implants placed in the posterior region. The results derived from the review process were described under several different topic headings to give readers a clear overview of the literature. In general, it was observed that the use of dental implants in posterior region requires a careful treatment plan. It is important that the practitioner has knowledge about the theme to evaluate the treatment parameters. CONCLUSION: The use of implants to restore the posterior arch presents many challenges and requires a detailed treatment planning.

Association of type 2 diabetes mellitus with the reduction of mandibular residual ridge among edentulous patients using panoramic radiographs

Objective: To evaluate the association between type 2 diabetes mellitus and the reduction of mandibular residual ridge in completely edentulous patients wearing complete dentures and to investigate the ef-fect of gender, age and years of edentulousness / den-ture wearing on ridge resorption on both groups. Methods: Seventy-two (36 men and 36 women) with a mean age 63.5 years (range of 52 to 73 years) com-pletely edentulous denture-wearing patients were included in this study. Of these, there were 40 patients with type 2 diabetes mellitus and 32 control subjects participated in the study. Resorption in the mandibular residual ridges was assessed by using the mental foramen and the inferior border of the mandible, as they appear in panoramic radiographs, as reference points using Wical and Swoope Analysis method. Measurements were performed using “Dijite” Digital Caliper. The amount of mandibular ridge resorption was calculated and correlated with type 2 diabetes mellitus and the results were compared with control group. Differences in gender, age and years of edentulousness were investigated. Statistical analysis was performed using SPSS (V11.0). A 2-sample t-test was used to evaluate the differences in mean values of mandibular ridge resorption between diabetics and controls. Level of significance was set at 0.05. Results: The mean mandibular residual ridge resorption of all participants is 8.0 mm (26.9%), diabetic group significantly (P < 0.01) had two times more resorption compared with control group (35.8% versus 18.0%). Females recorded greater amount of resorption in diabetics 49.7% versus 21.8% (P < 0.001) and in controls 22.3% versus 13.7%, (P < 0.05) compared to males, respectively. There were no differences in both groups regarding the age of subjects and the length of time they have been edentulous and years of denture wearing. The amount of mandibular residual ridge resorption was directly related to the number of years of edentulousness. Conclusion: Completely edentulous, denture-wearing diabetics, women in particular, are at more risk to have ridge resorption than “nondiabetic” subjects. Reduced mandibular height is directly related to years of edentulousness and denture wear-ing with greater amount of resorption among diabet-ics.

Study on recovery of combined defects including edentulous jaw,zygoma and orbit defects

Objective The magnetic retainer was used to respair combined defects including edentous jaw,zygoma and orbit defects to recover patients mastication,language and swallow functions.Method Impression models of jaw,zygoma and orbit were taken.Two prosthesis were connected by magnetic retainer.Result Fixation,and recovery of language and face shape were favorable for patients with magnetic retainer.Mastitating function was completely recovered in health side and partially in affected side.Conclusion The magnetic retainer provide sufficient retention and reliable connection.It can recover mastication with convenient wearing and taking.

Status of Oral Prosthetic Rehabilitation of Edentulism at the University Clinics of Kinshasa (CUK), DR Congo

Objective: The present work aimed to identify the most common edentulousness and prosthesis type (prosthetic treatment), to improve the management in oral prosthetic rehabilitation in DR Congo. Material and Methods: It was a documentary, longitudinal, and retrospective study of the medical records of edentulous patients admitted to the prosthetic service of the Dental Department/Kinshasa University from January 1983 to December 2020. Age, sex, cause of teeth loss, and prosthetic treatment (partial removable prosthesis, complete removable prosthesis) were evaluated. The Chare square test was performed to compare significant differences between the variables and the P-value < 0.05 was set as significant. Results: One thousand six hundred and ninety patients in that 901 were men (47 ± 16 years) and 789 women (42 ± 15 years) had undergone prosthetic treatment. One thousand eight hundred and forty-four edentulous teeth were viewed according to the Kennedy classification. Kennedy class 1 was the most predominant (61.4%) followed by Kennedy class 3 (24.8%). Two thousand one hundred and ninety-one prostheses were performed. The removable partial prosthesis with plate (acrylic resin) was the most performed (78.8%;n = 1727) and followed by the joint (17.4%;n = 384). Dental caries (52.6%) and periodontitis (36.4%) were the main causes of these edentulous teeth. Conclusion: The present study showed that edentulism is becoming a concern for the implementation of a real oral health policy.

无牙颌患者种植治疗修复空间与修复方式的选择策略

无牙颌患者在种植修复的设计过程中,应充分考虑患者建后的修复空间能否足够容纳种植义齿上部结构和修复体,根据修复空间选择合适的修复方式。目前存在的困难在于临床上对修复空间的评估尚无统一的标准。当口内的修复空间与修复体设计不匹配时,会出现种植义齿的机械或生物学并发症。本文综述并明确了无牙颌患者垂直高度和水平关系的评估方法,介绍了相应的无牙颌种植修复方式的临床决策。本文推荐:在无牙颌患者种植治疗之前,记录天然牙或旧义齿保留的正确的颌位关系;使用数字化技术,获得患者口腔颌面部完整的数字化信息,从而构建出三维虚拟牙科患者模型;根据测量得出的垂直修复空间和水平关系,设计以功能和美学为导向的种植修复方案。

48例Locator种植覆盖全口义齿5年临床修复效果评价

目的:观察Locator按扣式种植覆盖全口义齿的长期临床修复效果。方法:选择2016—2017年北京大学口腔医院门诊部采用Locator按扣式种植覆盖全口义齿修复的无牙颌患者48例,其中双颌全口义齿修复21例,单颌27例,共植入种植体230颗。观察种植体的留存率、种植体周黏膜探诊出血(BOP)、种植体周牙槽骨垂直吸收高度变化、义齿基托折裂和人工牙脱落折断等并发症,以及义齿固位力变化等。采用SPSS 13.0软件包对数据进行统计学分析。结果:在5年观察期间,5颗种植体脱落,1颗前牙区窄颈种植体颈部折断,12颗失访,种植体存留率为97.25%。种植修复后1年,48颗种植体周黏膜探诊出血(BOP+)(21.4%),平均出血指数(BI)为0.21±0.42,前牙区高于后牙区。种植体周牙槽骨垂直吸收高度为(0.21±0.35) mm,义齿基托折断2例。修复后5年,163颗种植体周黏膜探诊出血(BOP+)(76.89%),BI为1.00±0.70,种植体周牙槽骨垂直吸收高度为(0.58±0.85) mm;种植体周黏膜探诊出血指数与牙槽骨垂直吸收高度在男女之间、前牙区与后牙区之间均无统计学差异(P>0.05)。1年观察期和5年观察期间,种植体周黏膜平均出血指数、种植体周牙槽骨垂直吸收高度前后比较有显著差异(P<0.01)。义齿折裂17例,折裂率为26.15%,人工牙脱落折断率为16.92%,多发于前牙中线区及Locator基台附着体安放位置,因固位力下降首次更换Locator基台固位垫圈平均(34.2±10.3)个月。结论:Locator按扣式种植覆盖全口义齿有良好的临床修复效果。并发症多见于种植体周黏膜探诊出血和垂直向骨吸收,随着戴用时间延长有逐渐加重的趋势。其次是义齿基托折裂及人工牙脱落与折断,种植体脱落及折断。提示义齿制作时应加强金属支架在Locator基台位置和前牙中线区的强度,前牙区尽量避免使用窄径种植体。

无牙颌患者种植固定义齿饰面材料研究及应用进展

目前无牙颌患者种植固定义齿常用饰面材料包括丙烯酸树脂、聚合瓷、陶瓷、氧化锆等,不同材料的理化性质、临床表现各不相同。临床上固定义齿饰面材料的选择与患者口腔修复空间及软硬组织状况、力、生活习惯、口腔副功能、对颌牙材料及患者期望有关。无牙颌患者种植固定义齿相关的常见机械并发症为饰面材料的折裂/崩瓷及磨损,可通过咬合调整、修复体设计加工以及合适的修复材料选择予以规避。本文就常用无牙颌患者种植固定义齿饰面材料的特点、选择与设计要点、临床常见修复体材料相关并发症的病因及处理展开综述,以期为临床无牙颌患者种植固定义齿饰面材料的选择提供参考。

个别托盘预留空间厚度与牙槽嵴低平无牙颌义齿修复效果的关系

目的探究个别托盘不同预留空间厚度与牙槽嵴低平无牙颌义齿修复的关系。方法选择2020年3月至2023年3月期间于我院就诊的75例牙槽嵴低平无牙颌患者,采用随机数字表法将患者分为A组(n=25)、B组(n=25)和C组(n=25),3组分别按无预留空间(0 mm),预留空间(1.5 mm)和(2 mm)制作个别托盘并行全口义齿修复。对比3组患者的一般资料、修复有效率、VAS评分、TMD及PES评分,并分析3组患者修复后的满意程度评分。采用广义估计方程模型评价3组患者各项指标的改善情况。结果3组在终印与组织面的偏差值、复诊次数以及压痛位点之间存在显著差异,B组<C组<A组(P<0.05)。B组患者的总有效率高于A组和C组(P<0.05)。术后3个月,3组患者的VAS评分无明显差异,B组患者的TMD评分显著低于A组和C组,PES评分显著高于A组和C组(P<0.05)。比较3组患者对固位效果、稳定性、咀嚼功能、舒适度的满意度,B组患者的满意度明显高于A组和C组(P<0.05)。经广义估计方程分析可见:B组在TMD评分、PES评分、固位效果、稳定性、咀嚼功能、舒适度方面的改善情况优于A组和C组,C组在各方面的改善情况优于A组。结论个别托盘预留空间为1.5 mm时制作终义齿组织面与粘膜形态适合性较好、复诊次数和压痛位点较少、修复效果较好、患者的满意度较高。

数字化颌位关系记录与转移方法的研究进展

近年来,口腔数字化技术的日益成熟开启了全口种植修复的新时代。颌位关系的正确记录和转移是全口义齿修复成功的先决条件之一,相较于传统技术,数字化技术的应用可缩短患者的诊疗周期,提高诊疗效率。本文阐述了数字化技术在记录和转移无牙颌患者颌位关系时的应用和进展,深入探讨口腔数字化为临床医生带来的机遇与挑战,以期为临床医生在全口数字化技术的应用方面提供参考。

BPS吸附性义齿在全口牙列缺失患者中的临床应用

目的探讨吸附性义齿在牙槽嵴牙列缺失患者中的临床应用效果。方法选取2017年1月至2022年1月连云港市中医院口腔科收治的全口牙列缺失、牙槽嵴重度吸收、牙槽嵴不对称吸收等复杂情况的牙列缺失患者100例,按照信封法将其分为对照组(传统总义齿,n=50)和研究组(吸附性义齿,n=50)。统计并比较两组治疗前后咀嚼功能[咬合力占最大咬合力百分比(MABF/MMF)、咬合时间(OT)、左右侧咬合力平衡度(BFDB)、口香糖咀嚼物各像素点色调值标准化后的标准差(SDHue)]、吞咽及语言功能、治疗总满意度。结果治疗后,两组MABF/MMF较治疗前增高,OT、BFDB、SDHue较治疗前下降,且研究组MABF/MMF高于对照组,OT、BFDB、SDHue低于对照组,差异有统计学意义(P<0.05)。研究组吞咽及语言功能评分高于对照组,差异有统计学意义(P<0.05)。研究组治疗总满意度高于对照组,差异有统计学意义(P<0.05)。结论吸附性义齿修复复杂牙槽嵴情况的牙列缺失,可有效恢复患者咀嚼、吞咽及语言功能,并且患者的满意度较高。

两种方案设计下支架材料对无牙上颌种植固定修复影响的有限元分析

背景:在上颌无牙颌种植体支持式固定修复治疗中,上部支架结构材料的选择及不同远端种植体植入方式的设计密切影响着全口种植修复体的长期稳定性。目的:采用三维有限元方法,综合研究3种材料的上部支架及2种固定种植设计方案对上颌种植固定修复生物力学的影响。方法:根据1名健康成人正常颌的锥形束CT资料,采用Mimics软件分离上颌骨及上颌牙列三维实体模型,利用Geomagic Studio软件结合具体的模型参数构建无牙上颌全牙弓种植固定义齿的三维有限元模型。依据上颌后牙区远中种植体植入方式设计的不同,建立两种方案模型:方案1,按照临床常规应用的“All-on-4”设计,即2个种植体垂直植入上颌骨的双侧侧切牙区,另2个种植体则倾斜30°植入到双侧第二前磨牙区;方案2,即2个种植体垂直植入上颌骨的侧切牙区,后牙区采用2个短植体垂直植入双侧第二前磨牙区;在两种方案设计中使用3种材料(钛、氧化锆及聚醚醚酮)分别对上部支架结构进行赋值,得到6个模型,随后对比分析在斜向加载力方向下种植体、周围骨组织及上部支架结构的生物力学效果。结果与结论:①无论采用何种材料的上部支架,在两种无牙颌种植固定修复方案设计下,每个模型的最大应力峰值均分布于后侧种植体周围的颈部区域和皮质骨处;②与方案2中采用短种植体垂直植入的替代设计相比,方案1在上颌骨上显示出更为理想的应力分布;③由聚醚醚酮材料构建的支架模型,向上颌骨接近载荷区的种植体和周围骨组织传递了更高的应力,其次是钛、氧化锆;对于支架本身,聚醚醚酮上部支架内部应力峰值均明显小于氧化锆和钛支架;在3种上部支架材料中,选用氧化锆支架更有利于分散种植体及骨组织的应力分布;④结果提示,两种无牙颌种植固定修复设计方案都可以应用于临床实践,但从生物力学角度上考虑,方案1设计中的种植体、周围骨组织及上部支架的应力分散较为理性,更有利于无牙颌患者固定种植修复的远期预后;上部支架材料对种植体-骨界面的应力分布有着一定的影响。

无牙颌固定种植取模误吞事件1例及风险防范

本文报告1例无牙颌种植术后取模过程中误吞事件发生的详细经过,结合文献分析,总结意外误吞的预防和治疗措施,给临床医生以警示和参考,避免此类事故的发生。

无牙颌种植修复患者应用口内数字化印模准确性研究进展

随着种植技术和数字化技术的快速发展,口内数字化印模已是口腔种植修复中常用的印模方法。目前,口内数字化印模直接应用于无牙颌患者种植修复的准确性尚有所缺欠,这是由于无牙颌种植印模的准确性要求较高,而口内数字化印模尚存在识别和拼接的技术难点。对此,学者们提出了多种优化扫描策略的方法,如黏膜修饰法、辅助结构法、改良扫描杆法等,可在一定程度上提高无牙颌种植口内数字化印模的准确性。同时,立体摄影测量作为一种新兴的数字化印模方法正逐步发展成熟,准确性良好。本文从无牙颌种植修复口内数字化印模的准确性研究现状出发,综述了提高无牙颌种植口内数字化印模准确性的策略,以期为临床应用提供参考。

上颌牙列缺失患者种植支持固定修复前后唇部美学区软组织的变化

目的:探讨上颌牙列缺失患者种植固定修复治疗前后鼻唇部软组织的变化及其影响因素。方法:选择2016年1月—2023年7月于上海交通大学医学院附属第九人民医院口腔第二门诊行上颌全牙弓种植固定修复的患者50例。收集患者修复前后的病史、CBCT和三维面部扫描数据,采用配对t检验或Wilcoxon符号秩和检验比较患者戴牙前后软组织的改变,将各变化量与患者基本信息、种植方案和剩余骨相关参数进行双变量相关分析。使用赤池信息准则选择各软组织指标变化量的多元线性回归模型。结果:种植固定修复后,上唇长(sn-sto)、上唇红长(ls-sto)、上唇红面积(UVA)显著增加(P<0.01),上唇凸点到E线的距离(ls-E)显著减少(P<0.01),鼻唇角(∠cm-sn-ls)显著减小(P<0.01),人中长(sn-ls)无显著改变(P>0.05)。除sn-sto和sn-ls外,其余软组织改变量均与年龄呈正相关关系(P<0.01),其余骨组织参数、种植方案、性别与各软组织改变量无显著相关性。多元逐步后退回归分析显示,各软组织变化量与年龄和术前软组织情况广泛相关,个别与骨形态相关。结论:上颌牙列缺失患者种植固定修复后鼻唇部软组织发生显著变化,主要为唇红部扩大和突出。面部软组织变化主要与患者年龄及原有软组织条件广泛相关;患者年龄越大、原有软组织形态越凹陷萎缩,丰满度改善越明显,唇部凸度改变量与剩余骨形状也存在相关性。

基于以即刻修复为目标的动态导航下无牙颌种植手术护理配合

回顾性分析基于以即刻修复为目标的动态导航下无牙颌种植手术的护理配合要点。方法收集2019年1月—2023年5月收治的在动态导航系统引导下完成无牙颌种植手术伴即刻固定修复的42例患者的临床资料,分析动态导航技术的应用情况及护理配合特点。结果42例患者经过术前设计、术中导航均实现精确的种植体植入,种植体就位率达100%,并获得良好的初期稳定性,完成即刻固定修复,术后6个月并发症发生率为1.59%。结论动态导航辅助下的无牙颌种植手术需要护理人员熟练掌握动态导航理论知识、导航器械的安装使用及软件操作等相关技能,做好充足的术前准备以及默契的术中护理配合,以确保手术顺利完成。

上颌无牙患者种植即刻过渡义齿修复后侧貌软组织的轮廓变化

目的:比较上颌无牙患者在种植修复前与即刻过渡义齿修复后侧貌软组织轮廓变化,调查患者术后容貌满意度。方法:选择2018年1月至2022年12月于上海交通大学医学院附属第九人民医院行上颌种植即刻修复患者24例,收集患者修复前后病史、正侧位定位片,术前使用便携式三维面扫仪对患者进行面部扫描,设计种植即刻过渡义齿修复,行种植手术治疗。使用Dolphin Imaging 11.95软件分别对上颌无牙状态、种植即刻修复后状态下的头颅侧位片进行软组织角度测量,分析患者种植即刻过渡义齿修复前后角度变化,包括鼻唇角、prn'-sn'-ul'(Ls)、鼻尖角、全面突角、Z角、H角,以及线距测量项目,包括上唇距E线距离。术后使用电话问卷调查患者容貌满意度。采用SPSS 26.0软件包对数据进行统计学分析。结果:种植即刻过渡义齿前,无论男性还是女性,鼻唇角、上唇距E线距离均与标准值有显著差异,女性患者的Z角与标准值有显著差异。进行即刻过渡义齿修复后,男性、女性患者鼻唇角、上唇距E线距离与标准值无统计学差异;男性患者H角,女性患者鼻尖角与标准值有显著差异。男性与女性患者即刻过渡义齿修复后,鼻唇角、H角、上唇距E线距离与美貌人群标准值无统计学差异,全面突角、Z角与美貌人群标准值具有统计学差异。完成即刻过渡义齿修复后,相比种植治疗上颌无牙状态,患者的鼻唇角、Z角、H角均有显著变化。患者对种植即刻过渡义齿修复术后容貌满意度高。结论:种植即刻过渡义齿修复后,患者侧貌软组织轮廓即刻得到明显改善,侧貌软组织基本恢复到正常人水平,甚至部分达到美貌人群标准。进行种植即刻过渡义齿修复时,需结合患者主观美学诉求和个体情况,优化修复体功能和形态。

黏膜定位导板结合立体摄影测量技术在无牙颌种植即刻修复中的应用

目的:探讨黏膜定位导板结合立体摄影测量技术在无牙颌种植即刻修复中的应用效果。方法:选择2021年10月至2023年8月在郑州人民医院口腔医院就诊的10例半口牙列缺失患者,其中上颌2例,下颌8例。利用黏膜定位导板行种植体植入术,采用立体摄影测量技术获取印模,48 h内完成即刻固定修复。结果:10例共植入64颗种植体,植入方向较好,植入扭矩达0.35 Nm。种植体无脱落,种植体周围无明显骨吸收,修复体无松动,患者对修复效果满意。结论:对于骨质条件较好的无牙颌患者,黏膜定位导板结合立体摄影测量技术行即刻固定修复,近期疗效满意。

附着体-杆卡联合在颌骨缺损种植覆盖义齿修复中的应用

目的:探讨附着体-杆卡联合应用在颌骨缺损种植覆盖义齿修复中的疗效。方法:回顾笔者医院2018年10月-2021年9月应用附着体联合杆卡固位式种植覆盖义齿修复颌骨缺损伴牙列缺失26例患者资料,其中应用Locator附着体者12例,球帽附着体者14例,种植系统均为Straumann BL。对所有患者治疗完成后随访1年,使用义齿满意度视觉模拟评分表(Visual analogue scale,VAS)并结合临床检查对患者进行疗效评估,应用SPSS 22.0软件统计分析数据。结果:两种种植覆盖义齿在同一时间点义齿美观度、语音功能、咀嚼功能、固位功能、舒适性方面VAS评分比较差异无统计学意义(P>0.05);治疗后第1个月,两组义齿语音功能、咀嚼功能和舒适性方面评分低于其他三个时间点(P<0.05);在美观度和固位方面,两组义齿前后各个时间点差异无统计学意义(P>0.05)。临床检查见固位杆和义齿固位良好,未见种植体周围炎、固位杆松动、义齿破损及折断等并发症发生。结论:附着体-杆卡联合应用在颌骨缺损种植覆盖义齿修复中疗效满意,能够满足患者的需要。

无牙颌患者数字化全口义齿的修复效果及对咀嚼功能和稳定性的影响

目的:探讨无牙颌患者数字化全口义齿的修复效果以及对咀嚼功能和稳定性的影响。方法:将笔者医院2019年4月-2021年9月收治的60例无牙颌患者根据随机数字表法分为传统全口义齿组和数字化全口义齿组,每组30例。两组患者采取对应的治疗方式,分别在修复后3、6、12个月测定患者颞下颌关节紊乱指数(Craniomandibular index,CMI)、咀嚼功能、牙槽骨骨吸收量、咬合力以及咬肌表面肌电图(Surface electromyography,sEMG)并进行满意度评分。结果:修复后3、6、12个月,两组患者CMI均较修复前降低,且数字化全口义齿组低于传统全口义齿组(P<0.05)。两组患者咀嚼效率和咬合力均较修复前升高,且数字化全口义齿组高于传统全口义齿组(P<0.05)。数字化全口义齿组前牙区和后牙区下牙槽骨吸收量均低于传统全口义齿组,患者满意度评分均高于传统全口义齿组(P<0.05)。与修复前比较,两组患者修复后12个月紧咬棉棒5 s和牙尖交错位最大自主紧咬的sEMG值均增大,且数字化全口义齿组高于传统全口义齿组(P<0.05),而修复后下颌姿势位的sEMG值较修复前减小,且数字化全口义齿组小于传统全口义齿组(P<0.05)。结论:数字化全口义齿对无牙颌患者具有更好的修复效果,可有效提高患者的咀嚼效率和咬合力,减少牙槽骨吸收,提高患者满意度,增强佩戴稳定性,值得临床推广应用。